Labour government's courtship of the private sector is about to step up a gear

The announcement of a commitment to recruit a thousand more overseas doctors came, coincidentally we're told, on the anniversary of a similar deal with Spain the previous year.

That was a formal pact struck between Alan Milburn and his counterpart Celia Villalobos to send up to 5000 nurses to English hospitals.

Fresh plans to recruit more doctors aren't confined to Spain alone but it's likely to be one country that donates a substantial number.

No jobs

In the region of 20,000 Spanish doctors can't find a permanent job.

There are simply too many of them and there isn't the culture of moving between hospitals, so ingrained in doctors here.

In the region of 20,000 Spanish doctors can't find a permanent job

So a posting to England (and the deal is just England�where the shortages are worst) is attractive. The big unknown is will they stay?

They're likely to feel increasingly at home here if the Health Secretary forges ahead with his Spanish inspired project.

The Fundacion Hospital in Alcorcon, just outside Madrid, was the highlight of his visit.

The futuristic style hospital - where patients are rather curiously almost absent from view, prides itself on impressive waiting times and short patient stays.

Privately managed

Publicly owned but totally privately managed it shaves nearly a third off the waiting time typical of an Insalud (Spanish NHS) hospital.

How does it do it? Paying it's staff more; working them longer hours; sub contracting to other companies and investing millions in better system for diagnosis and computer technology.

Not surprisingly given his new found fondness for the private sector, the health secretary is interested�keen to explore the possibility of importing the idea into the NHS.

In a recent Fabian Society speech he gave the strongest indication yet for his plans to offer "greater plurality of provision" in the health service promising a longer term commitment to the private sector.

Up until now the private sector in Britain has supplied operations to the health service; it's taken on non clinical contracts like hospital cleaning and catering and of course has played a big role in building hospitals.

But the departure which Alan Milburn is signalling is that clinical services could soon be managed too.

Health factories

The three existing Fundacion hospitals in Spain have been accused of cherry picking the best patients

The setting in which this is likely to happen first is in the diagnosis and treatment centres - the so called "health factories" being built by the private sector to take on planned surgical work.

Unions have a problem with the whole idea of privately managed clinical care. So too do some of the professional bodies.

The three existing Fundacion hospitals in Spain have been accused of cherry picking the best patients - so that difficult cases are left for the Insalud (NHS) hospitals to deal with.

They've also been criticised for attracting the best staff - with local higher rates of pay - which they argue undermines the rest of the health care sector.

Bonuses though are already paid to good performers in the NHS back at home, so ministers will not have see it as being significantly different.

Alan Milburn knows the stakes are high. He needs to get waiting lists down and this offers an attractive solution by "giving more power to frontline staff" and freeing them of the shackles of healthcare bureaucracy.

It also lets central government off the hook when things go wrong.

Though the Fundacion hospitals put their profits back into patient services they're run as businesses all the same - and there are many in Britain who feel strongly that commercial imperatives and free healthcare for all - simply don't mix.